Archive for the 'The Wounded' Category

In my younger years I competed on the power lifting team at the college level (squat, bench and dead lift). I still lift, but haven’t been able to keep that trim form I had when I was twenty. I can’t imagine why. Really.

So my gym and workout buddy Jim competed in the Mid-Atlantic Classic bodybuilding championship recently, and he is the one on the left part of the photograph (or facing us, the one on the right).

More photos at NCMuscle.com. Jim turns 60 years old in a couple of weeks. That’s right. Sixty. That’s six followed by a zero. No, I don’t quite look like my buddy Jim.

Jim competed here (in this specific division) with guys less than half his age. He placed second. Jim and I both decided that we were glad that he didn’t win.

Here is the extremely fit Jim again.

Here is the thing. Look at the guy in the middle, who placed first. Take careful note of his right deltoid. It isn’t there. It was shot off during a combat tour in Iraq. Let’s see. Combat tour serving country. Get right deltoid shot off. Continue bodybuilding. Win competitions.

“If you become wounded – especially on your extremities but also even on your whole body – and a doctor begins to discuss rapidly propagating infection, or amputation of limbs, you need immediately to request that he administer 50 Rads of gamma or x-ray radiation to the affected area. If the infection doesn’t begin to retreat within 12 hours, request another 50 Rads. If the doctor doesn’t understand or wants to talk about this, have him call me. You know how to reach me at any hour, night or day.”

In the combat zones of Afghanistan and Iraq, soldiers often suffer shrapnel wounds and burns as a result of improvised explosive device blasts.

But other threats – bacteria, viruses and fungi – linger in the air and soil. Contact with the soldiers’ broken skin can lead to debilitating and potentially life-threatening infections.

With the goal of developing a treatment that can be applied to soldiers’ wounds at battle zones and hospitals to prevent infections, the U.S. Department of Defense allocated a $1.5 million grant to researchers at the University of Michigan and the NanoBio Corporation, the university announced Tuesday.

Researchers at the university’s Michigan Nanotechnology Institute for Medicine and Biological Sciences and the Ann Arbor-based NanoBio Corp., a biopharmeceutical company, will use the money to study the effects of nanoemulsion-based therapies on curbing wound and burn infections in combat situations.

“A broadly effective nanoemulsion-based wound treatment that can be safely and easily applied at the time of injury, without causing pain or interfering with wound healing, would have great value to prevent infection, increase survival and enable more rapid healing of wounded United States military personnel,” Dr. James R. Baker, the principal investigator for the grant, said in prepared remarks.

Nanoemulsions are made up of soybean oil, alcohol, water and surfactants emulsified into droplets 200 to 600 nanometers in diameter, according to the release. Research shows that nanoemulsions are effective in combating various bacteria and viruses.

The two research entities will develop 10 new nanoemulsion formulations against bacteria, fungi and spores in lab culture studies. The formulations will then be studied on animals for safety and effectiveness before moving on to human trials.

Nanoemulsions have shown promising results in other aspects of health care. The application of nanoemulsions for the treatment of cold sores is currently undergoing phase 3 clinical trials. Nanoemulsions have also been studied to treat cystic fibrosis infections and develop vaccines against influenza and bioterrorism agents.

The $1.5 million grant will be distributed to the University of Michigan and NanoBio Corp. over a three-year period.

U.S. President Barack Obama, who enjoys shooting hoops with family and friends, will take on a couple of tougher — and much taller –opponents Sunday: the Phoenix Suns’ Grant Hill and the Houston Rockets’ Shane Battier.

The game of presidential pickup will be held at Fort McNair in southwest Washington before an audience of “wounded warriors” and participants in the White House mentoring program, the White House press office said.

Hill told the Washington Post he was in town to play, along with a handful of other pros, including Battier.

First Shooter Obama, at 6’2”, will find some tough competition on the court: Hill and Battier, both forwards, are each 6’ 8”.

It’s been a bachelor sporting weekend for Obama, whose wife , Michelle, and younger daughter, Sasha, are in Spain and whose older daughter, Malia, is away at camp. On Saturday he played golf at Andrews Air Force Base.

Is this a bad joke? Let’s contrast one administration official with another. One might agree or disagree with the decisions made by Secretary Gates, but he cares about the men under his charge (from February 2008).

At the Marine Corps Association’s annual dinner in July, Gates cried while eulogizing Capt. Douglas Zembiec, a marine known as “the lion of Fallujah,” who had recently died in battle. By that time, Gates was writing personal notes at the bottom of every condolence letter sent to families of troops killed in battle. “I want the recipient of that note to know that the secretary of defense actually saw that letter, signed that letter, thought about that letter,” he told me on the plane ride back from Fort Hood. “It forces me to pay attention to every single one of the young people killed — how they died, where their hometown is, what other members of their unit were killed. I’ve kept count — 796 Americans have been killed in Iraq on my watch.” (This was as of Nov. 27.)

He takes his job seriously, and in fact doesn’t even really like the job due to the burden of it all. It could be that Obama doesn’t like his job either, but for different reasons than he takes it so seriously. I’m not even sure I know the two NBA players, but professional basketball has become a thuggish sport, and I don’t watch it.

Instead of spending time at Walter Reed or Bethesda Naval Hospital watching wounded warriors in rehabilitation, praying for them in their rooms out of sight of the cameras, urging them on, and ensuring that they get the best care possible, he is sporting it up in front of them. Get it? He expects them to watch him as he plays a game of fantasy ball with his heroes.

Closing GITMO has its price. The Chinese Muslims at GITMO, called the Uighurs, included four who had been cleared of charges by the U.S. Bermuda has agreed to take them in and allow them to pursue citizenship. As for the balance of the Chinese terrorists captured on the field of battle, all thirteen of them? Well, the tiny Island of Palau with a population of 20,000 has agreed to take them in for whopping $200,000,000. This amounts to $10,000 per person for every citizen.

Now. Let’s assume that front, rear and side SAPI plates (small arms protective inserts), plus the soft panel ballistic protection against shrapnel, plus the carrier, costs a total of $2000 for complete body armor (this figure is slightly to moderately exaggerated). This means that for what we have spent on sending thirteen terrorists to the Island of Palau we could have purchased 100,000 full sets of body armor for Soldiers and Marines.

It also means that wounded warriors who are being denied coverage will still have to plead with the authorities for full recognition of their wounds from war, both mental and physical. So while our warriors need body armor and rehabilitation and assistance, Chinese Muslim terrorists have been released to Bermuda (where most people cannot afford to go on vacation) and other such Islands.

This means that to finally address the issue of each Chinese Muslim terrorist has cost us $15,384,615. Extremely conservative estimates are that Baitullah Mehsud has around 20,000 fighters at his disposal. Disposal of them will cost us a mere 308 Billion Dollars if history is any indication of the future. It’s time for another spending package. Call up Timothy Geithner and tell him to get the printing presses rolling.

The Captain’s Journal had decided to wait before weighing in on the appointment of General Eric Shinseki to head Veteran’s Affairs. We’re glad we did.

Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance, but was told by lawmakers that it would be “dead on arrival” if sent to Congress.

Washington Sen. Patty Murray used that blunt terminology, telling Shinseki that the idea would not be acceptable and would be rejected if formally proposed. She made the remarks during a Senate Committee on Veterans Affairs hearing about the 2010 budget.

No official proposal to create such a program has been announced publicly, but veterans groups wrote a pre-emptive letter last week to President Obama opposing the idea after hearing the plan was under consideration. The groups also noticed an increase in “third-party collections” estimated in the 2010 budget proposal—something they said could only be achieved if the VA started billing for service-related injuries.

Asked about the proposal, Shinseki said it was under “consideration.”

“A final decision hasn’t been made yet,” he said.

A second senator, North Carolina Republican Richard Burr, said he agreed that the idea should not go forward.

“I think you will give that up” as a revenue stream, if it is included in this April’s budget, Burr said.

Sen. Murray said she’d already discussed her concerns with the secretary the previous week.

“I believe that veterans with service-connected injuries have already paid by putting their lives on the line,” Murray said in her remarks. “I don’t think we should nickel and dime them for their care.”

Eleven of the most prominent veterans organizations have been lobbying Congress to oppose the idea. In the letter sent last week to President Barack Obama, the veterans groups warned that the idea “is wholly unacceptable and a total abrogation of our government’s moral and legal responsbility (sic) to the men and women who have sacrificed so much.”

The groups included The American Legion, Disabled American Veterans, Military Order of the Purple Heart, Veterans of Foreign Wars of the United States and Iraq and Afghanistan Veterans of America.

At the time, a White House spokesman would neither confirm nor deny the option was being considere (sic).

Carefully consider what is happening here. Even if this move is fashioned as companies paying their fair share, it is still a dark, sinister and sinful plan. We are left without much to go on with the paucity of facts in the report above. But let’s assume the best – that veterans still get treatment in full, paid for by the VA, unless they happen to work for a company with insurance who covers injuries to veterans (without considering them a so-called pre-existing condition).

The problem here is that if company A doesn’t hire injured veterans, and company B does and also happens to have an insurance benefit, then company B is penalized. They are essentially taxed for having veterans under their employ. The economy is not a perpetual motion machine, or another way of saying it is that money doesn’t grow on trees, unless you work for the U.S. Treasury.

Medical insurance means that everyone contributes out of his or her paycheck towards the health of everyone. This cushion means that the company which hires any veteran who needs medical treatment (versus the company which doesn’t) is actually financially worse off because of it, especially small companies. Now for the problem. This is a disincentive for hiring veterans.

This scenario above is the best of all possible worlds, i.e., that all veterans are still covered for medical treatment in full. According to the information above, this simply isn’t so, and veterans might have to pay out of pocket for their treatment.

Many veterans come home and continue to fight for all they are worth to keep from dying, and then to live with their injuries and disabilities. They never leave the battle space.

So now Eric Shinseki must sit and ask himself what happened to his soul that he could abandon his fellow warriors on the field of battle like he has done, trying to save a few dollars while schemes are concocted to throw that very money away into useless programs. And then when he finally determines how he lost his soul, perhaps he will have enough of one left to feel the shame that will always be his for the rest of his life.

In a study of service members returning from Iraq and Afghanistan, researchers at the Rand Corporation found earlier this year that about 19 percent reported a possible traumatic brain injury while deployed, with 7 percent reporting a probable brain injury. An editorial last year in the medical journal the Lancet explained that due to increased use of explosive devices, the proportion of injured soldiers with TBI has increased to 60 percent, from 20 percent or less in previous wars. “With its mechanisms murky, diagnosis tricky, incidence under-reported, treatment uncertain, and personal, societal, and economic tolls enormous, TBI is a clear crisis for the U.S. military,” the editorial stated.

The results can be life-shattering. Even mild TBI, in which the victim never loses consciousness, can lead to erratic mood swings, impaired memory and confused thinking.

TBI used to be thought of as a single injury. But, over the past 10 or 15 years, a more complex picture has emerged.

“Now we know it’s a dynamic process,” said Dr. Ross Zafonte, professor and chair of the Department Physical Medicine and Rehabilitation at Harvard Medical School. “We like to separate it out into two parts.”

First is the immediate blow to the head. Neurons, the nerve cells that transmit and process information, might be stretched or torn apart entirely by the force. There might also be bleeding or swelling inside the skull, leading to more neuron damage.

But the process doesn’t end there. “There’s a whole chemical cascade,” said Lisa Kreber, senior neuroscientist and research coordinator for the Center for Neuroskills Clinical Research Education Foundation in Bakersfield, Calif.

“As neurons are damaged, chemicals and neurotransmitters get released in mass quantities. The blood-brain barrier might be compromised and calcium from your body could get into your brain. All that is toxic to brain cells, so you have further damage going on over the course of hours or days after the injury,” she said.

Trouble is, the damage isn’t always easy to spot. Axons, cable-like parts of neurons that form the fiber pathways information travels along, might not be completely broken, but could still be damaged from stretching and pulling. This kind of damage wouldn’t show up on an MRI or CT scan, Kreber said. So doctors might not realize anything is physically wrong.

But diffusion tensor imaging, a type of MRI, could change that by showing doctors the individual axon pathways. “You can see where the pathways have been stretched and where there are holes, so you have a better idea of how much damage has been done and to what parts of the brain,” she said.

Another possible diagnostic technique would sidestep imagery in favor of chemical analysis.

Serum biomarkers are substances, such as proteins or enzymes, which show up in higher-than-normal or lower-than-normal levels in the blood following specific types of damage. Hospitals already use a biomarker test to diagnose heart attack victims and researchers are looking for a way to make diagnosing TBI as simple.

“This is still in the research stage,” Bullock said. “But the idea is that you could take sample and know whether the person has had a brain injury, how severe it is, and whether there’s ongoing brain damage from hour to hour based on the biomarkers present in the blood.”

Once doctors know TBI has happened, treatment can begin. One of the most promising areas of research in treating TBI is in the field of neuroprotection, essentially finding substances that can protect neurons and give them an extra line of defense against secondary damage.

One example of neuroprotection comes from a study detailed June 27 in the Journal of Biological Engineering. Researchers Andrew Koob and Richard Borgens of Purdue University found that secondary damage might be lessened by giving victims an injection of polyethylene glycol.

Rats that got the injection within four hours of injury showed less behavioral impairment than those who didn’t get a shot at all or got one after that four-hour window. Because of the time constraint, this type of treatment would probably be most useful in situations where emergency personnel could reach victims quickly and give the injection before the patient ever reached a hospital.

Note this last warning. The techniques under study necessarily deal with rapid response and amelioration of the conditions in order to avoid TBI rather than the treatment of it. This is important. This means that in addition to training doctors at military hospitals, there will be required training of rapid reaction personnel, including but not limited to the Corpsman and medic.

This will be difficult, time consuming, expensive and risky. But it is worth it to protect the brain function of our warriors who have suffered battle space explosions. It would be sinful and criminal not to invest in this technology.

When my son deployed to Iraq in 2007, there were many things I wanted to say but didn’t have time. I used Motomail to accomplish much of this conversation over the next seven months (at times writing letters almost daily). One such letter must have been puzzling to him and I have not yet discussed it to see if he recalls the contents. I will do this soon. Maybe.

I had known for some time that the bacteria to which he would be exposed if wounded were somewhat different than any to which he had previously been exposed, and my counsel in this particular letter went something like the following: “If you become wounded – especially on your extremities but also even on your whole body – and a doctor begins to discuss rapidly propagating infection, or amputation of limbs, you need immediately to request that he administer 50 Rads of gamma or x-ray radiation to the affected area. If the infection doesn’t begin to retreat within 12 hours, request another 50 Rads. If the doctor doesn’t understand or wants to talk about this, have him call me. You know how to reach me at any hour, night or day.”

Strange? Why would I have so advised my son in a war zone? To begin with, a report on bacteria in Iraq (and elsewhere) was recently published that illuminates some of these issues.

“It’s why I lost my leg, so it sucks.”

The assessment, from a 22-year-old Marine toughing out physical therapy on two prosthetic limbs, is laconic, matter-of-fact. Sgt. David Emery lost one leg in February 2007 when a suicide bomber assaulted the checkpoint near Haditha, Iraq, where he and fellow Marines stood guard. Military surgeons were forced to remove his remaining leg when it became infected with acinetobacter baumannii-a strain of highly resistant bacteria that since U.S. forces began fighting in Iraq and Afghanistan has threatened the lives, limbs, and organs of hundreds wounded in combat.

“They could have saved it,” says Emery. “They had a rod in it, but then the bacteria was in too bad and my white blood cell count was up to 89,000-and they told my mom on a Friday that they had to take it.”

Emery’s mother recalls that the hazard was not confined to her son’s limbs.

“He ended up getting it in his stomach,” says Connie Emery, “and they tried to close his stomach back up, but when they did, the stitches ended up pulling away because the infection was taking over.”

An Army infectious disease physician says the germ has spread rapidly since the wars in Afghanistan and Iraq began. “Prior to the war, we were seeing one to two cases of acinetobacter infection per year,” remembers Lt. Col. Kimberly Moran, deputy director for tropical public health at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

“Now that’s much different. We’ve had hundreds of positive cultures over the last four years.”

Please, please read the entire article. If you read nothing else today, study this. This article will educate you and break your heart at the same time. The doctors are doing all they know to do with the equipment and procedures they have, and the article goes on to describe the potential for kidney damage if they break out the “big gun” antibiotics too soon, but potential loss of life if they don’t.

Back to my Motomail to my son. The answer for it is simple. Radiation hormesis. By definition, radiation hormesis is the “adaptive response of biological organisms to low levels of stress or damage, leading to a modest overcompensation to the disruption, and resulting in improved fitness.” Basically, the radiation causes greatly increased activity of the body’s immune and reconstructive systems. It has been tested on gas gangrene and other rapidly propagating infections, and there is no question as to its effectiveness. Much more material to study on this can be found at Biological Effects of Low Level Exposures.

Are you still not convinced? Then recall one of the final paragraphs of the report on Bacteria.

Researchers in military laboratories and elsewhere are exploring better means of fighting acinetobacter. Some are examining possible uses of radiation. At Harvard, Anderson is experimenting with a dye “painted” onto open wounds then activated with light. “Even the worst strains that are resistant to multiple antibiotics,” he says, “will succumb to the light-activated dye approach.”

Radiation is the answer. This is true whether you accept or reject (and I do reject) the LNTH (linear no threshold hypothesis) for radiation. The alleged risks are far outweighed by the advantages. Thus my letter to my son made sense, if he read and remembered it and could discuss it under duress – that is.

There are powerful arguments for General David Petraeus for man of the year. But even Petraeus doesn’t make it to the top of the list. Who then do we advocate for man of the year? He is Corporal Raymond D. Hennagir.

Corporal Hennagir is a brave warrior who lost both legs and four fingers to an IED, and his story is one of An Unforgettable Reunion.

CAMP LEJEUNE, N.C. – For 10 weeks, ever since Cpl. Raymond D. Hennagir was blown up, he had longed for this moment, this homecoming, when the rest of his platoon would return from Iraq.
He missed them, his brothers. Hennagir, a 21-year-old Marine from Deptford, N.J., felt he had let them down by stepping on an improvised explosive device (IED), blowing off both legs and four fingers on his left hand – now, he said, in his darkest Marine humor, just “a pink mist and a memory.”

Hennagir desperately wanted to mend enough so that the Marine Corps would let him travel to Camp Lejeune for this day, Aug 26.

That wish motivated him, maybe even kept him alive, through the summer’s 16 surgeries and three skin grafts. The pain was so intense that he was sure his screams were heard all through the National Naval Medical Center in Bethesda, Md.

“There were times when I wondered if the kid was ever going to get a break,” said his uncle Jim English, a 20-year Navy veteran, who would stare helplessly out the hospital window.

And now here Hennagir was. The late-August sun was blazing. He sat in his wheelchair, his baggy new jeans from American Eagle tucked up under his lost legs.

Read all of the story – it will make you weep for the brave men who have suffered TBI, lost limbs, and lost lives, and weep for their loved ones. And it will make you proud of their bravery.

But Corporal Hennagir is also a surrogate, and our nominating him man of the year is a vote for all of the wounded and all those warriors who have given it all for the cause. Men like Lance Corporal Dale G. Peterson, Lance Corporal Walter K. O’Haire, and Lance Corporal Jonathan E. Kirk of 2/6 who lost their lives in Fallujah during the summer of 2007 are also men of the year. It is men like these for whom I am truly thankful.

The U.S. Postal Service will not deliver any letter, post card, or package that is not addressed to a specific individual. Anything sent to “A Recovering Soldier,” “Any Wounded Soldier,” or “Any Service Member” is unacceptable.

“We cannot accept any mail that is not specifically addressed to an individual or an organization at the medical center,” says Terry Goodman of Walter Reed.

Sometimes one of these letters will make it through to the medical center. If that happens, it is returned to sender. Goodman says officials are just following Department of Defense policy designed to ensure the safety of patients and staff at all military hospitals.

And don’t try to contact Walter Reed or any other military medical facility to get the name of a wounded service member to write. Because of medical privacy regulations, hospital officials can’t give out that information.

A holiday greeting or a “Get Well” wish can brighten the day of a servicemember recovering at Walter Reed Army Medical Center.

However, hundreds of thousands of cards addressed to “Any Servicemember,” or a variant thereof, were returned to senders last year due to security concerns. A Defense Department policy in effect since 2001 specifically forbids the delivery of generically addressed mail to servicemembers.

This year two organizations have stepped in to ensure this type of mail makes it to servicemembers and does what it’s intended to do … boost morale.

Soldier’s Angels and the Red Cross serving the metropolitan Washington, D.C.-area will collect, screen, and deliver the well-wishes of those who want to brighten the day of a wounded servicemember recovering away from home this holiday season.

Those wishing to send a letter or a card to a recovering servicemember should send those cards to either:

Soldiers’ Angels
1792 E. Washington Blvd.
Pasadena, Calif. 91104

or

We Support You During Your Recovery!
c/o American Red Cross
P.O. Box 419
Savage, MD 20763-0419

But time is short. Your letter or card needs to be in the mail very soon. If you feel inclined to contribute more this Christmas season, there are many good charities associated with our service. Ralph Peters has a very moving commentary in the New York Post, Semper Fi, Semper Fi: Injured Marines Fighting On. He ends a very personal account of his visit with wounded Marines by saying:

You can donate to the Warrior and Family Support Center project via credit card by phone at 1-888-343-HERO or on the Web at ReturningHeroesHome.org.

To give by mail, send donations to:

Returning Heroes Home
P.O. Box 202194
Dallas, TX 75320-2194

Checks should be made out to Returning Heroes Home, Inc. This is a nonprofit 501c3 endeavor; all donations are tax-deductible.

All contributions, in any amount, will help our wounded warriors. Please give to those who gave so much.

Here is a short presentation of their mission and plan for the future.

Whatever you are inclined to do, please do so soon. I thank you, and our wounded warriors thank you.

At my request, Jack Holt kindly made a transcript available from the bloggers interview with Colonel Rice who leads the Army Wounded Warrior Program. I was unavailable to participate in the interview, but here is a sample.

COL. RICE: All right, well thank you for inviting me to talk to you about the U.S. Army Wounded Warrior Program. I’m honored to lead the U.S. Army Wounded Warrior Program and to serve the nation’s severely wounded, injured and ill soldiers and their families. This progress is here to serve those who have given so much to this country through their service. The U.S. Army Wounded Warrior Program follows the war ethos, “I will never leave a fallen comrade.” We assist and advocate for severely wounded soldiers and their families for as long as they need us, wherever they are located. The primary way the U.S. Army Wounded Warrior Program makes a difference in their lives — in the lives of the severely wounded soldiers and their families, is by taking the time to really listen to their needs. Every soldier in this Program is assigned a specialist who gives them personalized recovery assistance in navigating government and non-profit organizations on their behalf to ensure they get the help and support their families need. Our soldiers gave us their best, and we now remain committed to giving them ours. The U.S. Army Wounded Warrior Program is part of a larger Army initiative that is focusing on providing more comprehensive services to our soldiers and their families. We are in the forefront of an important transformation that is building the health care model for the future for the military’s wounded warriors. For more information on this program, or to obtain support services, any soldier or his loved one can call: 1-800-237-1336. They can also visit our website at: www.aw2.army.mil, where I recently posted the first entry in our new Army Wounded Warrior blog. Please take the time to learn more about the Program, our dedicated staff, and the severely wounded soldiers we serve. As director of the Army Wounded Warrior Program, my duty is also my honor, and I will continue to work every single day to make sure that no soldier is left behind.

Read the whole interview. Those who have followed this humble blog for a while know that this is a pet issue of mine, this issues of wounded warriors, caring for our fallen and injured, and properly managing our health care for these brave men. Regarding the so-called Walter Reed scandal, I have weighed in that General Weightman was probably not the right man to sack when the scandal broke. The problems were an ineffective and inefficient Department of Defense bureaucracy that didn’t support the wounded warrior when he left Walter Reed and went home, not when he was there. But be that as it may, the message today was that we are under management that cares and understands that the DoD must treat this holistically.

The advancements in battlefield medical care (e.g., Navy Corpsmen, Marines qualified as combat lifesaver, etc.) have ensured a drop in battlefield deaths, and yet a commensurate increase in battlefield wounded and “disabled.” The goal, then, is to ensure that the term “disabled” doesn’t really apply – to rehabilitate, to retrain, and to enable. May God grant them success.

As one final followup item, my regular readers also know that TBI (traumatic brain injury, the signature wound of the war due to IEDs) is a pet concern of mine. Here are two very interesting links for your study.